Chapter Quality Network (CQN)
Asthma Pilot Project
Team Progress Presentation
Oregon
Hillsboro Pediatric Clinic, LLC
Dana Nason, M.D.,
Nanette Dahlquist, M.D.
Cindy Donley, CPNP,
Sandra Alvarez, BS
Progress Summary Since
Learning Session 1
• Asthma Care protocol was found to be successful in
providing optimal quality asthma care to our identified
patients.
• Quality improvement systems increase the quality of
care offered on an ongoing basis.
• EQIPP data helped CQN asthma team evaluate and
discuss results with the medical providers to determine
the need for future changes or additions to both
process and content of standardized HPC asthma
patient care.
• Constructed manual registry.
Reasons for Success
• Built on previous asthma QI initiative and other
clinic QI projects through Tuality Health Alliance
“Gold Standard Program”.
• Selected asthma population from recall system
currently in place.
• Members of team have successfully worked
together for many years.
• A little “OCD” can go a long way.
Optimal Asthma Care
Spirometry
Asthma Action Plan
Flu Shot
First PDSA Cycle
PDSA Title: CQN form completion in waiting room
 Plan: test success of parent completion of CQN form filled out in
waiting room prior to asthma recall visits.
 Do: began with asthma patients of Dr. Nason; first day was not
part of routine, so readied forms were in drawer when first patient
arrived. The rest of the first day and subsequent days the forms
were handed out in the waiting room.
 Study: can be implemented with minimal impact to patient flow.
Successful test.
 Act: continue with current procedure expanding to additional
providers.
CQN Form Completion in Waiting Room
PDSA Ramp #1
TEST 4
What: parent completes CQN form while in waiting room
Who (population): asthma patients of Dr. Nason
Who (executes): Front office manager offered further training and education re:
importance of CQN form completion to front office staff.
Process returned to previous procedure: CQN team member identifies asthma patients on
schedule, prepares CQN form, adds alert “please give asthma form” on face sheet of EMR, and front office staff gives form to parent to
complete upon checking in.
Where: waiting room
When: while waiting for asthma recall appointment with Dr. Nason
TEST 3
What: parent completes CQN form while in waiting room
Who (population): asthma patients of Dr. Nason
Who (executes): CQN team member identifies asthma patients on schedule, prepares CQN form, created patient appointment list, and front office staff
gives form to parent to complete upon checking in.
Where: waiting room
When: while waiting for asthma recall appointment with Dr. Nason
TEST 2
What: parent completes CQN form while in waiting room
Who: (population): asthma patients of Dr. Nason
Who (executes): CQN team member identifies asthma patients on schedule, prepares CQN form, adds alert “please give asthma form” on face sheet of EMR. Front
office staff gives form to parent to complete upon checking in.
Where: waiting room
When: while waiting for asthma recall appointment with Dr. Nason
TEST 1
What: parent completes CQN form while in waiting room
Who (population): asthma patients of Dr. Nason
Who (executes): CQN team member identifies asthma patients on schedule, prepares CQN form, adds alert “please give asthma form” on face sheet
of EMR, and gives form to parent to complete upon checking in.
Where: waiting room
When: while waiting for asthma recall appointment with Dr. Nason
Expanding CQN Form Completion to All
Provider Participation: PDSA Ramp #2
TEST 4
What: parent completes CQN form while in waiting room
Who (population): asthma patients of all doctors and nurse practitioners
Who (executes): Front office staff
Where: waiting room
When: while waiting for asthma recall appointment with all doctors and nurse practitioners
TEST 3
What: parent completes CQN form while in waiting room
Who (population): asthma patients of all doctors
Who (executes): front office staff
Where: waiting room
When: while waiting for asthma recall appointment with all doctors
TEST 2
What: parent completes CQN form while in waiting room
Who: (population): asthma patients of Drs. Nason and Mandi
Who (executes): front office staff
Where: waiting room
When: while waiting for asthma recall appointment with Dr. Nason and Dr. Mandi
TEST 1
What: parent completes CQN form while in waiting room
Who (population): asthma patients of Dr. Nason
Who (executes): front office staff
Where: waiting room
When: while waiting for asthma recall appointment with Dr. Nason
Patients Counseled as to Importance of
Annual Flu Shots: PDSA Ramp #3
TEST 3
What: providers to counsel patients re: importance of annual flu immunization at all medical appointments
Who (population): asthma patients
Who (executes): CQN team to query individual providers when counseling not done is indicated on CQN form
Where: clinic setting
When: during all medical appointments
TEST 2
What: providers to counsel patients re: importance of annual flu immunization at all medical appointments
Who: (population): asthma patients
Who (executes): CQN medical leader re-educates medical providers to counsel patient re: flu vaccine if vaccine is unavailable
OR offers vaccine at all appointments if due. After re-education all medical providers to stress importance of annual flu shot
Where: clinic setting
When: during all medical appointments
TEST 1
What: provider to counsel patient as to importance of annual flu immunization OR offers flu vaccine during flu season
Who (population): all asthma patients
Who (executes): all medical providers
Where: clinic setting
When: during all medical appointments
Office Visit Prework
During Office Visit
Identify patients
with asthma recall
appointments.
Prepare the CQN
data collection form
On patient arrival,
appropriate language
form given to parent to
fill out first page in
WR (or completed in
exam room)
Post Visit
Activities
Parent given form
for completion in
exam room if not
received in waiting
room. MA checks
to see if any help
needed to
complete the form.
Language/reading
barriers?
Hillsboro Ped. Clinic Clinical Assessment Process Map –
Paper/EHR Chart System
Patient with new diagnosis of Asthma,
CQN form is pulled and filled out
completely during the visit.
Once parent
input is
completed,
the form is
placed
outside
exam door
MA will
obtain
spirometry
on patients
6 years
and older
If in active flu season
and vaccine is due,
administer flu shot. If
between seasons,
annual flu shot is
recommended.
All necessary
information on
the form is
entered into
EQIPP by the
CQN
administrative
team
member. (no
incomplete
entry.)
Completed
form scanned
into EHR.
MA selects
age
appropriate
asthma
recall
template
and asthma
control flow
sheet
Patient
is ready
to be
seen by
Provider
During the visit the
physician fills out
the remainder of
form while having
informed clinical
discussion
NO
NO
YES
Create flu
shot recall
Create
asthma
recall
YES
If necessary circle
back with provider to
obtain missing
information
CQN administrative team
member verifies form
completeness
NO
Provider
completes
the form,
template
and flow
sheet
immediately
after the visit
YES
Problem Areas:
*CQN forms being missed at patient check in.
*Incomplete forms turned in.
*Providers inaccurately completing form.
*Providers inconsistently creating future
recalls.
Solutions:
* Back office to give form when missed by
front desk.
*CQN team to return incomplete form to
provider for completion.
*CQN MD leader to question/counsel provider
on accuracy of information.
*CQN team member to review registry and
Input recalls into EMR. MD leader to
re-instruct providers on importance of recalls.
Provider
selects and
completes
asthma
initial
template
and
initiates
asthma
control flow
sheet.
Key Learnings
 PDSA cycles were not always successful but
remain educational.
 Different situations led to different barriers.
 Creating manual asthma registry taught us that
some asthma patients go unidentified,
resulting in lower rates of optimal asthma care.
 It is important to have buy-in of all staff
members to achieve goals successfully.
HPC Future Plans
• Expand from optimum episodic care to
improved population management with
sustainable protocols.
• Consider established registry for case
management.
• Continue providing optimal quality asthma
care to patients.
• Develop new asthma encounter form
questionnaire, similar to CQN encounter
form.